Early Intervention for Psychosis

1. Early Intervention for Psychosis Tom Craig

3. Compulsory Admission Factor OR (95% CI) A-Caribbean 2.3 (1.2-4.3) Black African 4.3 (1.9-9.9) Unemployed 1.9 (1.2-3.4) Mania 2.5 (1.2-5.1) Risk to others 1.9 (1.1-3.2) C. Justice 7.2 (3.7-13.9) Help-seeking 0.4 (0.2-0.7)

4. Referral Source 95% registered with GP but < 30% of Black groups come via GP In contrast >30% first contact via criminal justice system Less likely to seek help themselves Families more likely to call for help from police

5. Aims of an Early Intervention Service Reduce treatment delays & inequalities Maximise recovery : Provide integrated bio/psycho/social treatment Focus on functional outcomes Address co-morbidity and treatment resistance early Prevent relapse by: Ensuring assertive follow-up during critical period

6. Shortening DUP: The LEO-CAT Study GP education program for early identification Rapid assessment by crisis assessment team 9 am - 5 pm weekdays Emergency referrals seen within hours Non-emergency referrals seen within days If patient psychotic then LEO follow-up

7. Shortening DUP: Referrals to LEO-CAT (N= 197; values are days)

8. Shortening DUP: the TIPS Programme (Larsen et al, 2004)

9. Impact of Early Intervention

10. OPUS (Nordentoft & al)

12. LEO

13. LEO: Engagement at 18 Months

14. Use of compulsory treatments Difference between ethnic group remains but attenuated and now not significant

15. LEO Relapse at 18 Months (N=122)

16. The Spread of EI services

18. Mapping & Evaluation of London EIS Data from the London early intervention research network Of the 32 London boroughs in 2008 26 operational teams compared to just 12 in 2005 Most teams adopted stand alone structure (71%) Typical team 11 wte staff with caseload average 82 (range 0 � 177) Budget average �500, 830

19. EIS in LONDON

20. MiData Audit tool comprising minimum set of assessments to evaluate EIS Developed by LEIRN in 2004/2005 Clinicians make ratings based on routine clinical assessment at baseline and annually/discharge User-friendly Access database owned by each team with ratings directly inputted

21. Demographics Baseline data on 533 EIS clients 68% male, 78% single, 17% living alone Median age at referral 23 yrs (13-35) Majority born in UK (52%) 32% Black African/Caribbean 32% White British/European 27% no qualifications, 75% unemployed

22. Symptoms Mean total score on PANSS = 69 According to Leucht et al (05) this translates to �mildly ill� at time of referral to EIS Similar levels of positive & negative symptoms Using cut-off of 20 on Young�s Mania Scale, 17% of sample classified as manic

23. Other factors 38% of sample had abused substances in 6mths prior to referral with 29% abusing cannabis 7% attempted suicide in past 6mths & 16% committed a violent act towards someone else Median DUP of 2mths (0-196) between FPS and compliance with anti-psychotic medication

24. What happens after EI?

25. OPUS at 5 years (Bertelsen et al 2008) No difference in GAF Non significant difference in hospital bed days OPUS patients spent fewer days in supported housing 60% both groups unemployed

26. Early Intervention: Conclusions EI services can reduce treatment delay and compulsion The evidence for CBT for psychosis is least robust for early psychosis About 4% of EI patients end up in traditional rehabilitation services No EI service yet covers entire critical period Long term benefits remain uncertain at best